National, state, and local governments are responsible for safeguarding the health and safety of their citizens. Today, that responsibility means coping with unprecedented public health challenges, from both natural causes, such as the avian flu, and from deliberate attacks, such as bio-terrorism. To meet these challenges requires unprecedented levels of cooperation in and among agencies and organizations charged with protecting the safety of communities. Many of these organizations use either proprietary or incompatible technology infrastructures that need to be integrated in order to provide real-time, critical information for effective event monitoring, early event detection, and coordinated emergency response. Information must be shared instantaneously and among numerous entities to effectively identify and respond to a potential threat or emergency-related event.
Significant efforts are underway along these lines, for example, in the public health and bio-terrorism arena. The Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services has launched several initiatives aimed at forming nationwide networks of shared health-related information that, when fully implemented, will facilitate the rapid identification of, and response to, health and bio-terrorism threats. The CDC plans the Health Alert Network (HAN), for example, to provide infrastructure that supports distribution of health alerts, disease surveillance, and laboratory reporting. The Public Health Information Network (PHIN) is another CDC initiative that will provide detailed specifications for the acquisition, management, analysis and dissemination of health-related information, building upon the HAN and other CDC initiatives, such as the National Electronic Disease Surveillance System (NEDSS). Other U.S. government agencies, and international agencies, including the U.S. Food and Drug Administration (FDA), the U.S. Environmental Protection Agency (USEPA), the World Health Organization (WHO), and local affiliates of these organizations (e.g., state environmental protection agencies) are also involved in monitoring the outbreak of infectious diseases, or other medical problems, and limiting the spread thereof. These agencies have in place a number of other initiatives, including a Nationwide Health Information Network (NHIN), which will allow consumers to directly manage their personal patient information, with each consumer being able to access and review their information online through a personal data access portal while healthcare professionals utilize a separate and distinct portal. Another initiative is the Real-time Outbreak and Disease Surveillance (RODS) system, which is an open source, computer-based public health surveillance system for early detection of disease outbreaks. The RODS system is deployed in more than 18 states, Canada, and Taiwan, and was used during the 2002 Winter Olympics. Hospitals send RODS data from clinical encounters over virtual private networks and leased lines using the Health Level 7 (HL7) message protocol. The data are sent in real time. The RODS system automatically classifies a complaint from a hospital visit into one of seven syndrome categories using specific classifiers. The RODS system also has a Web-based user interface that supports temporal and spatial analyses. The RODS system processes sales of over-the-counter healthcare products, but receives such data in a batch mode on a daily basis. The RODS system has been and continues to be a resource for implementing, evaluating, and applying new methods of public health surveillance. Still other initiatives are; the Laboratory Response Network (LRN), the FDA's Food Safety Network (eLEXNET); the U.S. Department of Agriculture's FoodNet; the U.S. EPA's National Environmental Public Health Network (NEIEN); and the WHO's Global Outbreak and Alert Response Network.
These initiatives define functional requirements and set standards for interoperability of the information technology (IT) systems that hospitals, laboratories, government agencies and others will use in forming nationwide health networks; however, the initiatives do not solve the problems that exist due to the disparate nature of the data used in the initiatives, the differences between the agencies, and the often opposing needs for both security and quick access to data. For example, a single enterprise, such as a hospital, may have several separate database systems to track medical records, patient biographical data, hospital bed utilization, and vendors. The same is true of the government agencies charged with monitoring local, state and national health. In each enterprise, different data processing systems might have been added at different times throughout the history of the enterprise and, therefore, represent differing generations of computer technology. Integration of these systems at the enterprise level is difficult enough; integration on a national or global level is much more difficult. This lack of easy integration is a major impediment to surveillance, monitoring, identification and early detection, real-time event processing, and response planning and evaluation in the public health and bio-terrorism arenas.